Drug discovery for antiviral chemotherapy has provided the effective treatment of numerous viral diseases. Among antiviral agents used in therapy, nucleoside analogues have been particularly useful. In fact, almost twenty nucleosides are currently used in antiviral therapy, seven of which are for the treatment of HIV infection. In the search for new and effective agents within this class, the focus has recently expanded on L-analogues, characterized by opposite configuration compared to the natural D-nucleosides. The interest in L-nucleosides has risen since the discovery of 3TC, one of the most important drugs used in the treatment of AIDS and hepatitis B infection. This review will discuss the latest advances in L-nucleosides as antiviral agents with a particular focus on the synthesis and molecular mechanism as well as metabolic differences between L- and D-nucleosides.